from the deadly-embrace dept.
Kratom, an herbal drug made of ground-up tree leaves, is "temporarily" joining other natural substances such as cannabis, psilocybin, and peyote on the schedule I list of the Controlled Substances Act. The active ingredients in kratom, the indole alkaloids mitragynine and 7-hydroxymitragynine, are both being added to the list for up to three years, after which they can be added permanently.
Prior to this move, the U.S. has already been seizing shipments of kratom:
In 2014, the FDA issued an import alert that allowed US Customs agents to detain kratom without a physical examination. "We have identified kratom as a botanical substance that could pose a risk to public health and have the potential for abuse," said Melinda Plaisier, the FDA's associate commissioner for regulatory affairs. According to the DEA, between February 2014 and July 2016, nearly 247,000 pounds of kratom were seized.
Advocates say that kratom is a natural treatment for opioid addiction, an application that the Drug Enforcement Agency dismisses. Meanwhile, the heroin/opioid epidemic continues with "unprecedented" events like the recent 174 heroin overdoses in just six days in Cincinnati, Ohio.
Check out the implosion of this kratom subreddit, which is attempting to get 100,000 signatures on the White House petition site:
APATHY WILL GET US NOWHERE. IF THERE WAS EVER A TIME FOR US TO BAND TOGETHER, ITS NOW. stand with me brothers and sisters. hope is not lost.
The Obama administration is loosening restrictions on buprenorphine/Suboxone prescriptions in order to fight the "heroin epidemic", while calling on Congress to act on a request for $1.1 billion in additional funding for opioid treatment programs across the U.S.:
The Obama administration is making it easier for people addicted to opioids to get treatment. Health and Human Services Secretary Sylvia Burwell announced new rules Wednesday to loosen restrictions on doctors who treat people addicted to heroin and opioid painkillers with the medication buprenorphine. Doctors who are licensed to prescribe the drug, which is sold mostly under the brand name Suboxone, will be allowed to treat as many as 275 patients a year. That's almost triple the current limit of 100, and HHS estimated that as many as 70,000 more people may have access to the drug as a result.
"There are a number of ways we are trying to increase access to medication-assisted treatment," said Michael Botticelli, the director of national drug control policy, on a conference call with reporters. "This rule itself expands access and gets more physicians to reach more patients."
Suboxone is itself an opioid. It eases withdrawal symptoms and cravings, but doesn't make people high. [...] Botticelli said an average 129 people a day die from opioid overdoses.
White House Announces Heroin Response Strategy for the US Northeast
Alarming Rise in Death Rates for Middle-Aged White Americans
Kroger Supermarkets to Carry Naloxone Without a Prescription
4/20: Half-Baked Headline
When customers want a longer-lasting high, heroin dealers respond by augmenting their products with drugs like carfentanil:
A powerful drug that's normally used to tranquilize elephants is being blamed for a record spike in drug overdoses in the Midwest. Officials in Ohio have declared a public health emergency, and the U.S. Drug Enforcement Administration says communities everywhere should be on alert for carfentanil. The synthetic opioid is 100 times more potent than fentanyl, the prescription painkiller that led to the death earlier this year of the pop star Prince. Fentanyl itself can be up to 50 times more deadly than heroin.
In the past few years, traffickers in illegal drugs increasingly have substituted fentanyl for heroin and other opioids. Now carfentanil [alt link] is being sold on American streets, either mixed with heroin or pressed into pills that look like prescription drugs. Many users don't realize that they're buying carfentanil. And that has deadly consequences.
"Instead of having four or five overdoses in a day, you're having these 20, 30, 40, maybe even 50 overdoses in a day," says Tom Synan, who directs the Hamilton County Heroin Coalition Task Force in Southwest Ohio. He's also the police chief in Newtown, Ohio. Synan says carfentanil turned up in Cincinnati in July. At times, the number of overdoses has overwhelmed first responders. "Their efforts are truly heroic, to be going from call to call to call," he says. "One district alone had seen 14 in one shift, so they were nonstop."
First responders and emergency room workers are being told to wear protective gloves and masks. That's because carfentanil is so potent, it can be dangerous to someone who simply touches or inhales it. This was devastatingly clear back in 2002, after a hostage rescue operation in Moscow that went wrong. To overpower Chechen terrorists who'd seized control of a theater, Russian Special Forces sprayed a chemical aerosol into the building. More than 100 hostages were overcome and died. Laboratory tests by British investigators later revealed [open, DOI: 10.1093/jat/bks078] [DX] that the aerosol included carfentanil.
In the article about the DEA adding kratom to Schedule I, I mentioned an "unprecedented" amount of "heroin" overdoses in Cincinnati. The carfentanil-cut heroin boosted the overdose tally to 174 in 6 days (225 in Ohio, Indiana, Kentucky, and New Jersey):
Deaths have not spiked along with the overdose reports because police officers or emergency medical technicians are immediately administering naloxone, sometimes in more than one dose, to bring heroin users back to consciousness and start them breathing.
The blowback against the U.S. Drug Enforcement Administration's decision to ban kratom has caught the attention of a bipartisan group of legislators, but a DEA spokesman has said that "It's not a matter of if. It's simply a matter of when" the DEA bans kratom:
A bipartisan group of nine senators is calling on the Drug Enforcement Administration to delay its "unprecedented" decision to ban kratom, a plant that researchers say holds great potential for mitigating the effects of the opioid epidemic. [...] The Senate letter, spearheaded by Orrin G. Hatch (R-Utah) says: "Congress granted emergency scheduling authority to the DEA based on the need for law enforcement interdiction of new and previously unknown illegal synthetic street drugs that result in injuries and death. The use of this emergency authority for a natural substance is unprecedented, so it is important to determine whether the circumstances here necessitate a jump to Schedule I.
"Given the long reported history of Kratom use," the letter continues, "coupled with the public's sentiment that it is a safe alternative to prescription opioids, we believe using the regular review process would provide for a much-needed discussion among all stakeholders." [...] The DEA cites 600-plus poison-control center calls involving kratom between 2010 and 2015 in its justification for banning the plant, and notes that 15 deaths were linked to the use of the plant between 2014 and 2016. In an interview with The Washington Post, a DEA spokesman later clarified that all but one of those fatalities involved the use of other substances. Earlier this week 51 U.S. representatives similarly called on the DEA and the White House to reconsider or at least delay the ban, which was slated to go into effect as early as Friday. In an interview, DEA spokesman Russell Baer confirmed that the ban was not yet in place. "We have not yet determined a date when we will publish that final order" putting the ban into effect, he said.
There may be a public comment period before the ban takes effect, and the White House is now obligated to respond to the petition about kratom, which has reached over 140,000 signatures.
Previously: DEA Welcomes Kratom to the Schedule I List Beginning September 30
Heroin, Fentanyl? Meh: Carfentanil is the Latest Killer Opioid
Alcohol Industry Bankrolls Fight Against Legal Pot in Battle of the Buzz [Updated]
More organs have become available for transplant in British Columbia, Canada, due to a rise in drug overdoses:
After a brutal year where more than 900 people died of drug overdoses in British Columbia, doctors are pointing to one morbid upside. It might sound like something out of a dystopian horror comic, where drug users are wiped out and harvested for organs. New stats released by the health agency responsible for organ transplants show that's not exactly a far-off nightmare anymore. Health officials have noticed a significant uptick in organ donor deaths, and say that fentanyl is likely playing a role. According to BC Transplant, the number of organ donors in the first weeks of 2017 has doubled over this time last year, from 10 to 20. That's resulted in 59 transplants, up from 37 organs over the same period in 2016.
[...] "We started tracking the connection between fentanyl and organ donation more closely at the start of 2017, and fentanyl has been a contributing factor in about a quarter of our donors so far this year." BC Transplant's statement cautions against drawing conclusions based on a small amount of recent data. But long term trends show the proportion of organ donors dying from overdose has gone up steadily over many years. Back in 2013, 7.5 percent of organ donors tested positive for drugs. In 2016, that number rose to 22.7 percent.
Previously: Opioid Addiction is Big Business
Obama Administration Expands Access to Suboxone Treatment
DEA Welcomes Kratom to the Schedule I List Beginning September 30
Heroin, Fentanyl? Meh: Carfentanil is the Latest Killer Opioid
The Calm Before the Kratom Ban
Since this time last year, Ohio, Florida, North Dakota, and Arkansas legalized medical cannabis, Illinois decriminalized it, and California, Nevada, Maine and Massachusetts legalized recreational cannabis. An attempt to legalize recreational cannabis in Arizona narrowly failed.
29 U.S. states and the District of Columbia have legalized cannabis for medical use, although restrictions vary widely from state to state.
Germany's medical cannabis law was approved in January and came into effect in March. Poland has also legalized medical cannabis, and Georgia's Supreme Court has ruled that imprisonment for possession of small amounts of cannabis is unconstitutional.
🍁 Cannada: Not So Fast 🍁
Last week, Canadian Prime Minister Justin Trudeau unveiled (archive) legislation (archive) that would make Canada the first major Western country to legalize recreational cannabis (the only country to legalize it to date is Uruguay, although implementation has taken years), dealing a serious blow to the crumbling United Nations Single Convention on Narcotic Drugs. However, the Liberal Party of Canada intends to wait more than a year to act on its campaign promise, during which time Canadians can still face prosecution for possession of the drug:
True to form, this government has written down a series of talking points, in this case, trying to make it sound like it's cracking down on pot rather than legalizing it. And Justin Trudeau's ministers are sticking to the messaging from party central like a child reciting Dr. Seuss.
Not once in that As It Happens interview did [Justice Minister Jody] Wilson-Raybould explain why the government intends to keep on criminalizing Canadians so unfairly (see the Liberal party's website statement) for another year. Instead, literally every second time she opened her mouth, she re-spouted the line about "strictly regulating and restricting access." Off asked eight questions. Four times, Wilson-Raybould robotically reverted to the same phrase.
Meanwhile, Public Safety Minister Ralph Goodale, a parliamentary lifer who mastered the art of repetitive dronetalk sometime back in the last millennium, was out peddling more or less the same line, but with an added warning: Not only will the government continue to criminalize Canadians for what it considers a trifling offence, enforcement will be vigorous. "Existing laws prohibiting possession and use of cannabis remain in place, and they need to be respected," Goodale declared. "This must be an orderly transition. It is not a free-for-all." Why the government cannot simply decide to invoke prosecutorial and police discretion, and cease enforcing the cannabis laws it considers unjust, was not explained. Why that would necessarily be a "free for all" also went unexplained.
The Liberal Party of Canada has taken pains to remind everyone that the Conservative Party will "do everything they can to stop real change and protect a failed status quo". Unfortunately, they did not get the memo that "marijuana" is a term with racist origins.
Make like a tree and legalize it, Cannadia... Cannibinoidia.
President Trump and Attorney General Jeff Sessions
Backtrack to April 20th, 2016. Bernie Sanders still seemingly had a shot at becoming the President of the United States. Sanders, as well as Hillary Clinton (though begrudgingly), supported decriminalization of cannabis, medical use, and the continuation of states making decisions about recreational use. The #2 Republican candidate Ted Cruz also had a "let the states sort it out" stance.
One contender stood out, and he went on to become the @POTUS to #MAGA. The widely predicted "third term" was prevented, and that outcome may greatly affect a burgeoning semi-legal cannabis industry. One recent casualty are Amsterdam-style "cannabis clubs" (think: brewpubs). Colorado's legislature has backed off on a bill that would have allowed on-site consumption of cannabis at dispensaries due to the uncertain future of federal enforcement of cannabis prohibition.
Trump's position on cannabis has been ill-defined, although he supports medical use and has indicated that states should handle the issue. But the same can't be said of his Attorney General, former Senator Jeff Sessions. Here are some quotes about the drug from Mr. Sessions:
We need grown-ups in charge in Washington to say marijuana is not the kind of thing that ought to be legalized, it ought not to be minimized, that it's in fact a very real danger.
I think one of [President Obama's] great failures, it's obvious to me, is his lax treatment in comments on marijuana... It reverses 20 years almost of hostility to drugs that began really when Nancy Reagan started 'Just Say No.
You can't have the President of the United States of America talking about marijuana like it is no different than taking a drink... It is different... It is already causing a disturbance in the states that have made it legal.
Good people don't smoke marijuana.
Cannabis advocates are becoming increasingly paranoid about the federal government's stance towards the states (and a certain District) that have legalized cannabis. And this is following an Obama administration that was criticized for conducting raids in states with legalization. It is too early to tell how the Trump administration will choose to deal with cannabis, but there are signs that harsher policies and greater enforcement could be coming:
On Wednesday, [April 5th,] Jeff Sessions directed Justice Department lawyers to evaluate marijuana enforcement policy and send him recommendations. And some state officials are worried. This week the governors of Alaska, Colorado, Oregon and Washington wrote the attorney general. They asked Sessions and the new Treasury secretary to consult with them before making any changes to regulations or enforcement.
At the White House, press secretary Sean Spicer said recently that the president is sympathetic to people who use marijuana for medical reasons. He pointed out that Congress has acted to bar the Justice Department from using federal money to interfere in state medical cannabis programs. But Spicer took a harsh view of recreational marijuana. "When you see something like the opioid addiction crisis blossoming in so many states around this country, the last thing we need to be doing is encouraging people. There is still a federal law we need to abide by," Spicer said.
Really, Spicer? Recreational cannabis use shouldn't be encouraged during an opioid addiction crisis? Read on.
Politics nexus unavailable for comment.
The Opioid Crisis Drags On (it's relevant)
Heroin use has become more dangerous as dealers have increasingly added other substances that massively increase potency without affecting the size of a dose significantly. Carfentanil, which is used as an elephant tranquilizer, has led to hundreds of deaths over very short timespans. It is impossible for the average user to predict the potency and potential danger of street heroin. While there have been international responses to these compounds, new chemical analogues are being created all the time:
Chinese labs producing the synthetic opiates play hide-and-seek with authorities. On their websites, they list fake addresses in derelict shopping centers or shuttered factories, and use third-party sales agents to conduct transactions that are hard to trace. The drugs themselves are easy to find with a Google search and to buy with a few mouse clicks. A recent check found more than a dozen Chinese sites advertising fentanyl, carfentanil, and other derivatives, often labeled as "research chemicals," for sale through direct mail shipments to the United States. On one website, carfentanil goes for $361 for 50 grams: tens of thousands of lethal doses.
The cat-and-mouse game extends to chemistry, as the makers tinker with fentanyl itself. Minor modifications like adding an oxygen atom or shifting a methyl group can be enough to create whole new entities that are no longer on the list of sanctioned compounds. Carfentanil itself was, until recently, unregulated in China.
2016 saw the addition of kratom to Schedule I of the Controlled Substances Act in the U.S. Advocates for the tree leaf drug, which was formerly classified as a supplement, believe that its painkiller effects and low risk factors make it a useful replacement for the oft-deadly opioids that millions of Americans are addicted to. Kratom users have treated their pain and opioid withdrawal symptoms using the formerly "legal high". The DEA has refused to acknowledge this application and points out the "skyrocketing" number of calls to the Poison Control Center regarding kratom in recent years. One skeptic of kratom, Dr. Josh Bloom of the American Council on Science and Health, has looked at the same evidence and concluded that the trail of bodies left by substances like fentanyl and the scarce number of deaths (perhaps wrongly) attributed to kratom make it clear that the substance is the better "poison". He also notes that:
The number of calls to poison control centers is not reliable for determining how many poisonings actually occurred. It is a crude approximation at best.
Much like kratom, medical cannabis has been touted as a solution to the opioid crisis. States with legalized medical cannabis have seen a reduction in reported instances of opioid dependence [DOI: 10.1016/j.drugalcdep.2017.01.006] [DX] So it is puzzling that White House Press Secretary Sean Spicer would use opioids as a bludgeon against cannabis legalization while AG Sessions expresses astonishment over the suggestion of using cannabis as a "cure" for the opioid crisis.
Bonus: Here's a video (2m14s) of a woman getting administered Narcan/naloxone. Here's an alternate video (2m39s) in which a man who overdosed on heroin is able to sit up in about a minute after being administered naloxone.
⚚ The Slow March for Science ⚕
While the Drug Enforcement Agency has refused to reclassify cannabis from its current Schedule I status, citing the supposedly rigorous conclusions reached by the Food and Drug Administration, it will allow more than one institution to grow cannabis for research purposes, ending the monopoly held by the University of Mississippi. However, the Schedule I status of cannabis remains an impediment to further research:
[...] DEA's decision not to reschedule marijuana presents a Catch-22. By ruling that there is not enough evidence of "currently accepted medical use"—a key distinction between the highly restrictive Schedule I classification and the less restrictive Schedule II—the administration essentially makes it harder to gather such evidence.
"They're setting a standard that can't be met," says David Bradford, a health economist at the University of Georgia, Athens. "That level of proof is never going to be forthcoming in the current environment because it requires doing a really extensive clinical trial series, and given that a pharmaceutical company can't patent whole plant marijuana, it's in no company's interest to do that."
Schedule I status presents obstacles for clinical researchers because of restrictions on how the drugs must be stored and handled, Bradford says. Perhaps more significant, that listing may evoke skittishness at funding agencies and on the institutional review boards that must sign off on research involving human subjects.
"It doesn't resemble cannabis. It doesn't smell like cannabis," Sisley told PBS NewsHour last week.
Jake Browne, a cannabis critic for the Denver Post's Cannabist marijuana news site, agrees. "That is, flat out, not a usable form of cannabis," he said. Browne should know: He's reviewed dozens of strains professionally and is running a sophisticated marijuana growing competition called the Grow-Off.
"In two decades of smoking weed, I've never seen anything that looks like that," Browne said. "People typically smoke the flower of the plant, but here you can clearly see stems and leaves in there as well, parts that should be discarded. Inhaling that would be like eating an apple, including the seeds inside it and the branch it grew on."
Research on cannabinoids and psychedelics is proceeding, slowly. One study published yesterday (74 years after the first LSD trip) came to an astounding conclusion: Psychedelics can induce a "heightened state of consciousness":
Healthy volunteers who received LSD, ketamine or psilocybin, a compound found in magic mushrooms, were found to have more random brain activity than normal while under the influence, according to a study into the effects of the drugs. The shift in brain activity accompanied a host of peculiar sensations that the participants said ranged from floating and finding inner peace, to distortions in time and a conviction that the self was disintegrating.
[...] What we find is that under each of these psychedelic compounds, this specific measure of global conscious level goes up, so it moves in the other direction. The neural activity becomes more unpredictable," said Anil Seth, a professor of neuroscience at the University of Sussex. "Until now, we've only ever seen decreases compared to the baseline of the normal waking state."
Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin (open, DOI: 10.1038/srep46421) (DX)
♯ Ending on High Notes ♯
And now to scrape the bottom of the barrel:
- Americans Don't Care If Their Parents Know They Smoke Weed, Survey Says
- California Today: At Newspapers, Covering Pot Like Wine (archive)
- Nation's first public needle vending machine for drug users debuts in Las Vegas
- GRiZ Won the Celebrity Weed Game Without Selling Out
- Secret A.T.F. Account Paid for $21,000 Nascar Suite and Las Vegas Trip (archive)
- Legal Marijuana Ends at Airport Security, Even if It's Rarely Stopped (archive)
- Anti-Heroin Video From a Florida Sheriff Appalls Critics but Impresses Constituents (archive)
"The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don't start, they won't have a problem." – President Donald J. Trump
President Trump has declared the "Opioid Crisis" a nationwide public health emergency. This action will allow for "expanded access to telemedicine services" to remotely prescribe medicines for substance abuse, allow the Department of Health and Human Services to "more quickly make temporary appointments of specialists with the tools and talent needed to respond effectively to our Nation's ongoing public health emergency", allow the Department of Labor to issue dislocated worker grants for those "displaced from the workforce" due to the Opioid Crisis, and will help people with HIV/AIDS to receive substance abuse treatment. The press release lists several actions that the Trump Administration has taken to respond to the Opioid Crisis, including the July 2017 law enforcement action against AlphaBay.
The declaration has been criticized for not requesting any funds to respond to the Crisis. The "nationwide public health emergency" declaration is also distinct from a promised "national emergency declaration", which would have freed up money from the Disaster Relief Fund to be spent on the Crisis. 14 Senate Democrats have introduced a bill that would authorize $45 billion to address the Opioid Crisis. The Obama Administration called on Congress last year to pass just over $1 billion in funding for opioid treatment programs nationwide. This funding was included in the 21st Century Cures Act.
The Department of Justice has arrested and charged the founder and majority owner of Insys Therapeutics Inc., John Kapoor, along with other executives from his company. Kapoor is accused with leading a nationwide conspiracy to bribe doctors and illegally distribute the company's fentanyl spray, intended for cancer patients, so that it could be prescribed for non-cancer patients. Kapoor stepped down as CEO of Insys in January. Acting U.S. Attorney William D. Weinreb said, "Mr. Kapoor and his company stand accused of bribing doctors to overprescribe a potent opioid and committing fraud on insurance companies solely for profit. Today's arrest and charges reflect our ongoing efforts to attack the opioid crisis from all angles. We must hold the industry and its leadership accountable - just as we would the cartels or a street-level drug dealer." Six former Insys executives and managers were charged in December.
The FDA has issued a public health advisory warning of deaths related to kratom (Mitragyna speciosa) and warning against using it to treat opioid withdrawal symptoms. The DEA attempted to temporarily regulate kratom as a schedule I drug in 2016, but stopped short of doing so after a public backlash. From FDA Commissioner Scott Gottlieb's statement on the advisory:
It's very troubling to the FDA that patients believe they can use kratom to treat opioid withdrawal symptoms. The FDA is devoted to expanding the development and use of medical therapy to assist in the treatment of opioid use disorder. However, an important part of our commitment to this effort means making sure patients have access to treatments that are proven to be safe and effective. There is no reliable evidence to support the use of kratom as a treatment for opioid use disorder. Patients addicted to opioids are using kratom without dependable instructions for use and more importantly, without consultation with a licensed health care provider about the product's dangers, potential side effects or interactions with other drugs.
There's clear data on the increasing harms associated with kratom. Calls to U.S. poison control centers regarding kratom have increased 10-fold from 2010 to 2015, with hundreds of calls made each year. The FDA is aware of reports of 36 deaths associated with the use of kratom-containing products. There have been reports of kratom being laced with other opioids like hydrocodone. The use of kratom is also associated with serious side effects like seizures, liver damage and withdrawal symptoms.
Given all these considerations, we must ask ourselves whether the use of kratom – for recreation, pain or other reasons – could expand the opioid epidemic. Alternatively, if proponents are right and kratom can be used to help treat opioid addiction, patients deserve to have clear, reliable evidence of these benefits.
FDA Commissioner Scott Gottlieb has released a new statement denouncing the drug kratom. The statement says that the FDA has learned about new deaths that "involved" kratom use, additional adverse effects associated with its use have been found, and that Public Health Assessment via Structural Evaluation (PHASE) "3-D computer technology" has been used to analyze the chemical compounds in kratom:
Using this computational model, scientists at the FDA first analyzed the chemical structures of the 25 most prevalent compounds in kratom. From this analysis, the agency concluded that all of the compounds share the most structural similarities with controlled opioid analgesics, such as morphine derivatives.
The FDA continues to discourage the use of kratom, which it is calling an opioid.
An outbreak of 28 salmonella infections in 20 states has been linked to kratom products, the US Centers for Disease Control and Prevention said in a statement Tuesday. Though no deaths have been reported, 11 people have been hospitalized.
[...] California had the highest number of salmonella cases (three). North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania and Utah each reported two cases while Alabama, Arizona, Colorado, Florida, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, North Dakota, New York, South Carolina and Tennessee each reported a single case, the CDC found.
Kratom should not be consumed in any form, the CDC said, because the source of salmonella contamination has not been identified.
Previously: DEA Welcomes Kratom to the Schedule I List Beginning September 30
The Calm Before the Kratom Ban
FDA Blocks More Imports of Kratom, Warns Against Use as a Treatment for Opioid Withdrawal
FDA Labels Kratom an Opioid